EASTWICK COLLEGE
N212 Pathophysiology
Exam 3 — Comprehensive
2026 Academic Year
Course: N212 Pathophysiology Exam: Exam 3
Total 100 (Multiple Choice) Points: 100 points (1 pt each)
Questions:
Time Limit: 2 hours Format: Closed book
Name: Student ID:
Instructor: Date:
INSTRUCTIONS
• This exam contains 100 multiple-choice questions covering cardiovascular, respiratory, renal, endocrine,
neurological, gastrointestinal, hepatic, immune, hematologic, musculoskeletal, and integumentary pathophysiology.
• Each question has four options (A, B, C, D). Select the single best answer for each question.
• There is no penalty for guessing, so answer every question even if unsure.
• Questions are designed at mixed difficulty: approximately 40% recall/comprehension, 40% application, and 20%
analysis/clinical reasoning.
• An Answer Key with Rationales appears at the end of the exam. A Topic Index is provided for self-assessment
and review.
• Use of calculators, textbooks, notes, or electronic devices is not permitted.
EXAMINATION — 100 QUESTIONS
ANSWER KEY AT THE END
1. A 56-year-old male presents with intermittent claudication. Examination of the arterial wall reveals fatty streaks
progression to fibrous plaques. Which process is the primary initiator of atherosclerotic plaque formation?
A. Proliferation of smooth muscle cells into the tunica media
B. Endothelial injury with subsequent lipid accumulation and macrophage infiltration
C. Calcification of the arterial elastic lamina
D. Thrombus formation on intact endothelium
Page 1
,N212 Pathophysiology — Exam 3 Eastwick College · 2026
2. A patient presents with crushing substernal chest pain. ECG shows ST elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Obtuse marginal artery
3. A 45-year-old with hypertension has elevated renin and angiotensin II levels. Which mechanism directly contributes
to the sustained elevation in blood pressure in this patient?
A. Angiotensin II–mediated vasodilation and decreased aldosterone
B. Angiotensin II–mediated vasoconstriction and increased aldosterone secretion
C. Conversion of angiotensin I to bradykinin
D. Decreased renal sodium and water reabsorption
4. A patient with left-sided heart failure develops pulmonary edema. Which compensatory mechanism, although
initially helpful, ultimately worsens cardiac workload over time?
A. Activation of the sympathetic nervous system causing tachycardia and increased contractility
B. Decreased renal perfusion causing sodium wasting
C. Parasympathetic-mediated bradycardia
D. Vasodilation of peripheral arterioles reducing afterload
5. A patient with a prosthetic mitral valve develops fever and a new murmur. Echocardiography reveals vegetations.
Which pathologic feature characterizes these vegetations?
A. Sterile fibrin deposits on valve leaflets
B. Masses of platelets and fibrin with embedded microorganisms
C. Calcific nodules on valve commissures
D. Ruptured chordae tendineae
6. Following a massive anterior MI, a patient develops hypotension, cold extremities, and oliguria. Which
hemodynamic profile is most consistent with cardiogenic shock?
A. Decreased cardiac output, increased systemic vascular resistance, increased pulmonary capillary wedge
pressure
B. Decreased cardiac output, decreased systemic vascular resistance, normal pulmonary capillary wedge pressure
C. Increased cardiac output, decreased systemic vascular resistance, decreased pulmonary capillary wedge
pressure
D. Increased cardiac output, increased systemic vascular resistance, increased pulmonary capillary wedge
pressure
7. A patient with chronic atrial fibrillation is at increased risk for which complication, and what is the underlying
mechanism?
A. Hemorrhagic stroke due to ruptured cerebral aneurysms
B. Ischemic stroke due to thrombus formation in the left atrial appendage
C. Pulmonary embolism due to right ventricular stasis
D. Myocardial infarction due to coronary vasospasm
Page 2
,N212 Pathophysiology — Exam 3 Eastwick College · 2026
8. Which combination of risk factors for coronary artery disease is considered non-modifiable?
A. Hypertension, diabetes, smoking
B. Age, male sex, family history
C. Obesity, sedentary lifestyle, hyperlipidemia
D. Stress, alcohol consumption, diet
9. A patient with aortic stenosis develops exertional angina, syncope, and dyspnea. Which hemodynamic change is the
primary consequence of severe aortic stenosis?
A. Volume overload of the right ventricle
B. Increased left ventricular pressure with concentric hypertrophy
C. Decreased pulmonary artery pressure
D. Dilation of the aortic root
10. A 28-year-old presents with sharp, positional chest pain that worsens with inspiration and improves when leaning
forward. ECG shows diffuse ST elevation. Which finding is most specific for the diagnosis?
A. Pericardial friction rub
B. Pulsus paradoxus greater than 10 mmHg
C. Bilateral pleural effusions
D. Elevated cardiac troponin
11. A patient with metastatic breast cancer presents with hypotension, muffled heart sounds, and jugular venous
distention. Which pathophysiologic process explains this triad (Beck's triad)?
A. Accumulation of fluid in the pericardial space compressing the heart
B. Rupture of a papillary muscle causing acute mitral regurgitation
C. Massive pulmonary embolism causing right heart failure
D. Tension pneumothorax compressing the mediastinum
12. A postoperative patient develops a deep vein thrombosis. Which component of Virchow's triad is most directly
related to the surgical procedure itself?
A. Endothelial injury
B. Hypercoagulability
C. Venous stasis
D. Valvular incompetence
13. A 70-year-old male with long-standing hypertension develops an abdominal aortic aneurysm. Which pathologic
process is the primary contributor to aneurysm formation?
A. Atherosclerotic weakening of the arterial media with destruction of elastin and collagen
B. Hyperplasia of the tunica intima
C. Congenital absence of smooth muscle cells
D. Excessive vasoconstriction of the vasa vasorum
Page 3
, N212 Pathophysiology — Exam 3 Eastwick College · 2026
14. A 35-year-old male has a family history of sudden cardiac death. Echocardiography reveals asymmetric septal
hypertrophy with systolic anterior motion of the mitral valve. Which diagnosis is most likely?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Arrhythmogenic right ventricular cardiomyopathy
15. A 65-year-old smoker develops cramping leg pain that occurs after walking two blocks and resolves with rest.
Which pathophysiologic mechanism best explains the symptoms?
A. Arterial occlusion causing inadequate blood supply during exertion
B. Venous insufficiency causing pooling of blood
C. Lumbar spinal stenosis causing nerve compression
D. Diabetic neuropathy causing sensory disturbance
16. An 8-year-old child with asthma experiences wheezing after exposure to dust mites. Which inflammatory
mediators are primarily responsible for acute bronchoconstriction?
A. Histamine and leukotrienes released from sensitized mast cells
B. Complement C3a causing direct alveolar damage
C. Tumor necrosis factor causing capillary leak
D. Bradykinin from kinin system activation
17. A 60-year-old long-term smoker has chronic productive cough and dyspnea. Pulmonary function tests show
decreased FEV1/FVC ratio. Which pathologic finding distinguishes emphysema from chronic bronchitis?
A. Permanent enlargement of airspaces distal to the terminal bronchiole with wall destruction
B. Mucous gland hyperplasia in the bronchial wall
C. Persistent cough with sputum production for at least 3 months in 2 consecutive years
D. Reversible bronchoconstriction triggered by allergens
18. A 72-year-old develops fever, productive cough, and right lower lobe consolidation. Sputum culture grows
Streptococcus pneumoniae. Which host defense mechanism is most often impaired in elderly patients
predisposing them to pneumonia?
A. Mucociliary clearance and impaired cough reflex
B. Surfactant production
C. Pulmonary vascular resistance
D. Alveolar macrophage metabolic activity
19. A postoperative patient suddenly develops dyspnea, tachycardia, and pleuritic chest pain. Arterial blood gas shows
respiratory alkalosis with hypoxemia. Which pathophysiologic mechanism explains the hypoxemia?
A. Increased dead space due to perfusion of non-ventilated alveoli
B. Increased shunt due to ventilation of non-perfused alveoli
C. Ventilation-perfusion mismatch with low V/Q ratio in affected areas
D. Diffusion impairment across the alveolar-capillary membrane
Page 4
N212 Pathophysiology
Exam 3 — Comprehensive
2026 Academic Year
Course: N212 Pathophysiology Exam: Exam 3
Total 100 (Multiple Choice) Points: 100 points (1 pt each)
Questions:
Time Limit: 2 hours Format: Closed book
Name: Student ID:
Instructor: Date:
INSTRUCTIONS
• This exam contains 100 multiple-choice questions covering cardiovascular, respiratory, renal, endocrine,
neurological, gastrointestinal, hepatic, immune, hematologic, musculoskeletal, and integumentary pathophysiology.
• Each question has four options (A, B, C, D). Select the single best answer for each question.
• There is no penalty for guessing, so answer every question even if unsure.
• Questions are designed at mixed difficulty: approximately 40% recall/comprehension, 40% application, and 20%
analysis/clinical reasoning.
• An Answer Key with Rationales appears at the end of the exam. A Topic Index is provided for self-assessment
and review.
• Use of calculators, textbooks, notes, or electronic devices is not permitted.
EXAMINATION — 100 QUESTIONS
ANSWER KEY AT THE END
1. A 56-year-old male presents with intermittent claudication. Examination of the arterial wall reveals fatty streaks
progression to fibrous plaques. Which process is the primary initiator of atherosclerotic plaque formation?
A. Proliferation of smooth muscle cells into the tunica media
B. Endothelial injury with subsequent lipid accumulation and macrophage infiltration
C. Calcification of the arterial elastic lamina
D. Thrombus formation on intact endothelium
Page 1
,N212 Pathophysiology — Exam 3 Eastwick College · 2026
2. A patient presents with crushing substernal chest pain. ECG shows ST elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Obtuse marginal artery
3. A 45-year-old with hypertension has elevated renin and angiotensin II levels. Which mechanism directly contributes
to the sustained elevation in blood pressure in this patient?
A. Angiotensin II–mediated vasodilation and decreased aldosterone
B. Angiotensin II–mediated vasoconstriction and increased aldosterone secretion
C. Conversion of angiotensin I to bradykinin
D. Decreased renal sodium and water reabsorption
4. A patient with left-sided heart failure develops pulmonary edema. Which compensatory mechanism, although
initially helpful, ultimately worsens cardiac workload over time?
A. Activation of the sympathetic nervous system causing tachycardia and increased contractility
B. Decreased renal perfusion causing sodium wasting
C. Parasympathetic-mediated bradycardia
D. Vasodilation of peripheral arterioles reducing afterload
5. A patient with a prosthetic mitral valve develops fever and a new murmur. Echocardiography reveals vegetations.
Which pathologic feature characterizes these vegetations?
A. Sterile fibrin deposits on valve leaflets
B. Masses of platelets and fibrin with embedded microorganisms
C. Calcific nodules on valve commissures
D. Ruptured chordae tendineae
6. Following a massive anterior MI, a patient develops hypotension, cold extremities, and oliguria. Which
hemodynamic profile is most consistent with cardiogenic shock?
A. Decreased cardiac output, increased systemic vascular resistance, increased pulmonary capillary wedge
pressure
B. Decreased cardiac output, decreased systemic vascular resistance, normal pulmonary capillary wedge pressure
C. Increased cardiac output, decreased systemic vascular resistance, decreased pulmonary capillary wedge
pressure
D. Increased cardiac output, increased systemic vascular resistance, increased pulmonary capillary wedge
pressure
7. A patient with chronic atrial fibrillation is at increased risk for which complication, and what is the underlying
mechanism?
A. Hemorrhagic stroke due to ruptured cerebral aneurysms
B. Ischemic stroke due to thrombus formation in the left atrial appendage
C. Pulmonary embolism due to right ventricular stasis
D. Myocardial infarction due to coronary vasospasm
Page 2
,N212 Pathophysiology — Exam 3 Eastwick College · 2026
8. Which combination of risk factors for coronary artery disease is considered non-modifiable?
A. Hypertension, diabetes, smoking
B. Age, male sex, family history
C. Obesity, sedentary lifestyle, hyperlipidemia
D. Stress, alcohol consumption, diet
9. A patient with aortic stenosis develops exertional angina, syncope, and dyspnea. Which hemodynamic change is the
primary consequence of severe aortic stenosis?
A. Volume overload of the right ventricle
B. Increased left ventricular pressure with concentric hypertrophy
C. Decreased pulmonary artery pressure
D. Dilation of the aortic root
10. A 28-year-old presents with sharp, positional chest pain that worsens with inspiration and improves when leaning
forward. ECG shows diffuse ST elevation. Which finding is most specific for the diagnosis?
A. Pericardial friction rub
B. Pulsus paradoxus greater than 10 mmHg
C. Bilateral pleural effusions
D. Elevated cardiac troponin
11. A patient with metastatic breast cancer presents with hypotension, muffled heart sounds, and jugular venous
distention. Which pathophysiologic process explains this triad (Beck's triad)?
A. Accumulation of fluid in the pericardial space compressing the heart
B. Rupture of a papillary muscle causing acute mitral regurgitation
C. Massive pulmonary embolism causing right heart failure
D. Tension pneumothorax compressing the mediastinum
12. A postoperative patient develops a deep vein thrombosis. Which component of Virchow's triad is most directly
related to the surgical procedure itself?
A. Endothelial injury
B. Hypercoagulability
C. Venous stasis
D. Valvular incompetence
13. A 70-year-old male with long-standing hypertension develops an abdominal aortic aneurysm. Which pathologic
process is the primary contributor to aneurysm formation?
A. Atherosclerotic weakening of the arterial media with destruction of elastin and collagen
B. Hyperplasia of the tunica intima
C. Congenital absence of smooth muscle cells
D. Excessive vasoconstriction of the vasa vasorum
Page 3
, N212 Pathophysiology — Exam 3 Eastwick College · 2026
14. A 35-year-old male has a family history of sudden cardiac death. Echocardiography reveals asymmetric septal
hypertrophy with systolic anterior motion of the mitral valve. Which diagnosis is most likely?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Arrhythmogenic right ventricular cardiomyopathy
15. A 65-year-old smoker develops cramping leg pain that occurs after walking two blocks and resolves with rest.
Which pathophysiologic mechanism best explains the symptoms?
A. Arterial occlusion causing inadequate blood supply during exertion
B. Venous insufficiency causing pooling of blood
C. Lumbar spinal stenosis causing nerve compression
D. Diabetic neuropathy causing sensory disturbance
16. An 8-year-old child with asthma experiences wheezing after exposure to dust mites. Which inflammatory
mediators are primarily responsible for acute bronchoconstriction?
A. Histamine and leukotrienes released from sensitized mast cells
B. Complement C3a causing direct alveolar damage
C. Tumor necrosis factor causing capillary leak
D. Bradykinin from kinin system activation
17. A 60-year-old long-term smoker has chronic productive cough and dyspnea. Pulmonary function tests show
decreased FEV1/FVC ratio. Which pathologic finding distinguishes emphysema from chronic bronchitis?
A. Permanent enlargement of airspaces distal to the terminal bronchiole with wall destruction
B. Mucous gland hyperplasia in the bronchial wall
C. Persistent cough with sputum production for at least 3 months in 2 consecutive years
D. Reversible bronchoconstriction triggered by allergens
18. A 72-year-old develops fever, productive cough, and right lower lobe consolidation. Sputum culture grows
Streptococcus pneumoniae. Which host defense mechanism is most often impaired in elderly patients
predisposing them to pneumonia?
A. Mucociliary clearance and impaired cough reflex
B. Surfactant production
C. Pulmonary vascular resistance
D. Alveolar macrophage metabolic activity
19. A postoperative patient suddenly develops dyspnea, tachycardia, and pleuritic chest pain. Arterial blood gas shows
respiratory alkalosis with hypoxemia. Which pathophysiologic mechanism explains the hypoxemia?
A. Increased dead space due to perfusion of non-ventilated alveoli
B. Increased shunt due to ventilation of non-perfused alveoli
C. Ventilation-perfusion mismatch with low V/Q ratio in affected areas
D. Diffusion impairment across the alveolar-capillary membrane
Page 4
